Healthcare Provider Details

I. General information

NPI: 1306792403
Provider Name (Legal Business Name): ALEXIS DAVIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 W COLLIN RAYE DR
DE QUEEN AR
71832-2943
US

IV. Provider business mailing address

1429 W COLLIN RAYE DR
DE QUEEN AR
71832-2943
US

V. Phone/Fax

Practice location:
  • Phone: 501-525-4855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ALEXIS DAVIS
Title or Position: CEO
Credential:
Phone: 501-525-4855